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Topical anesthesia appears safe for strabismus surgery
J Pediatr Ophthalmol Strabismus. 2009;46(4):218-222.
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Topical anesthesia may be useful for strabismus surgery, but surgeons may opt to have an anesthesiologist nearby in case conversion to general anesthesia becomes necessary.
Use of topical anesthesia requires a larger conjunctival opening than would be used with general anesthesia, and muscle traction should be avoided, according to a retrospective review of 101 randomly selected cases undergoing strabismus surgery under topical anesthesia. Bleeding may be increased compared with procedures performed under general anesthesia.
"The oculocardiac reflex is infrequent," the study authors said. "Pain is caused by conjunctival manipulation and traction on extraocular muscles, so particular care must be taken with these actions."
According to the review, a satisfactory result, as defined by a squint angle less than 10 ΔD and absence of diplopia, was achieved in 95% of patients immediately after surgery. By the end of follow-up, 85% of patients had achieved a satisfactory result. Overall, diplopia was reduced from 49% at baseline to 8% postoperatively.
Conversion to general anesthesia was not required in any case, and atropine was used in three patients after induction of the oculocardiac reflex.